World AIDS Vaccine Day: Igniting the prevention revolution

There’s one bromide any decent physician endorses — the one about an ounce of prevention being worth a pound of cure. When it comes to ending the AIDS pandemic, U.S. policymakers from both sides of the aisle have embraced this notion as well, providing unwavering, bipartisan support for the global effort to end AIDS, which has already claimed nearly 30 million lives and left another 33 million infected.

U.S. government support for research into HIV prevention — most notably an AIDS vaccine — has been crucial to seeding what scientists are calling a prevention revolution. Without it, we would not be where we are today: The sheer risk of taking on AIDS vaccine development is a significant disincentive to private sector investment. This has resulted in a classic market failure that can only be surmounted with government support. World AIDS Vaccine Day provides an opportunity to consider why this support is also smart long-term policy — why it makes sense not just in medical terms, but in financial ones as well.

Indonesian volunteers light candles during a ceremony to mark World AIDS Day in Jakarta. Photo Credit: Adek Berry/AFP

Because there is no cure for AIDS, over the next few decades this merciless disease will continue to dismantle the familial networks that sustain and stabilize human society in many poor nations and, in some of them, sow the seeds of lasting political instability. As we have all learned in the past decade, such instability has a way of reaching around the world. Today some 5 million of the most vulnerable people in such places have access to HIV drugs today, thanks mainly to the President’s Emergency Plan for AIDS Relief launched by George W. Bush, and the U.S.-funded Global Fund to Fight AIDS, Tuberculosis and Malaria.

Still, every day, an additional 7,100 people become HIV positive, and for each person put on antiretroviral drugs, two are newly infected by the virus. While indispensible, the provision of HIV treatment cannot keep pace with this modern plague.

Even in the U.S., there are 56,000 new HIV infections each year, and the government spends $16.7 billion domestically on treatment and care for AIDS. The only medically and fiscally sane option we have is to find an efficient way to reverse the tide of new infections. Vaccines provide that option. As illustrated by recent efforts of the International AIDS Vaccine Initiative (IAVI) — which is led by the author of this piece — when done right, support for such research has the added benefit of spurring innovation in American industry.

Fortunately researchers have, with government support, made significant headway to that end. In 2009, a clinical trial in Thailand, conducted by U.S. military and Thai researchers, demonstrated for the first time that vaccines can in fact prevent HIV.

Meanwhile, researchers at and affiliated with IAVI have over the past two years isolated fifteen antibodies capable of neutralizing a broad spectrum of globally circulating HIV variants; others, at the National Institutes of Health, have independently found similarly powerful antibodies. Each of these discoveries holds valuable clues to the design of more effective HIV vaccine candidates.

But to harness them, we must find ways to bypass the market failure that discourages industry involvement. As a nonprofit public-private product development partnership, IAVI, with the support of its donors — most notably USAID — picks up much of the risk associated with developing promising AIDS vaccine concepts, and so draws industry into such efforts.

Second, the organization identifies and actively cultivates promising but neglected avenues of related research. As part of that effort, IAVI has in partnership with the Bill & Melinda Gates Foundation launched an Innovation Fund that seeks out biotech companies working on a variety of biomedical problems and supports the application their technology to solve the major problems of AIDS vaccine development.

It was from this fund that IAVI provided Theraclone Sciences, a small Seattle-based biotechnology firm seed funding to apply its technology to help isolate neutralizing antibodies. The success of this joint effort wasn’t just good for the field of HIV prevention. It was also good for Theraclone. Partly on the strength of its work with IAVI, the start-up won an agreement with a Japanese drug company to develop therapies and vaccines against influenza and, more recently, established an exclusive partnership with Pfizer for cancer and infectious disease therapies that could eventually be worth more than $600 million.

Just as the U.S. space program generated countless engineering innovations, solving the AIDS vaccine problem will have a lasting impact on one of the greatest growth industries of the future: biological therapies and vaccines, especially those relevant to emerging markets around the world.
We are today at a tipping point in our journey toward an AIDS vaccine. In these economically tough times, we must not forget the long term cost-savings promise of AIDS vaccines — and keep doing all we can to make that promise a reality.
Seth Berkley is the president and CEO of the International AIDS Vaccine Initiative.